A World Health Organization Collaborating Center for Injuries, Violence and Accident Prevention

News

Every day, more than 32 children between the ages of 1-4 die in Bangladesh due to drowning. That's more than 12,000 children a year. In fact, while the mortality rates of childhood diseases like diarrhea or malaria have decreased, in large part due to disease prevention and nutritional interventions, the rate of child drowning has increased, especially in low-income countries like Bangladesh, because there has not been a similar investment in prevention. It's not surprising, then, that drowning is the leading cause of death for this age group in the country. But drowning, like most unintentional injuries, is a preventable cause of death.

The Johns Hopkins International Injury Research Unit (JH-IIRU) is committed to reducing the burden of child injuries around the world. That's why, on February 27, 2014, JH-IIRU joined Bloomberg Philanthropies in Dhaka, Bangladesh, to launch the Drowning Prevention Project, a $10 million initiative aimed at identifying scalable drowning interventions in this low-lying South Asian country.

As part of this project, JH-IIRU will work in collaboration with the International Center for Diarrhoeal Disease Research, Bangladesh (icddr,b) and the Center for Injury Prevention and Research Bangladesh (CIPRB), to initiate the Saving of Lives from Drowning (SoLiD) in Bangladesh. SoLiD is an implementation study that has been established to test the effectiveness of two interventions to prevent and reduce the burden of childhood drowning in Bangladesh. The interventions will be implemented along with family education and community awareness on drowning prevention.

Adnan A. Hyder, MD, MPH, PhD, director of JH-IIRU, will lead a team that will directly address two major factors in preventable child drowning deaths in a country where 7% of its surface is covered in water-lack of supervision and easy access to water. The project will test two interventions: community daycare centers (sometimes referred to as "crèches" or "anchals") playpens. Attendance in crèches during the period when drowning injury is most likely to occur reduces the risk of drowning by both supervising the child and removing the child from the hazard. Similarly, playpens, which will be locally manufactured, restrict child mobility, thus creating a barrier between the child and the hazard. They are also an aid to adult supervision, which, in turn, minimizes exposure to the risk of drowning.

The goal of the project is to monitor and evaluate the effectiveness of these interventions for 80,000 children, 1-4 years of age over a two-year period.

"The rate of drowning for young children in Bangladesh is alarming," said Hyder. "It is imperative that we explore the feasibility of appropriate and cost-effective drowning prevention interventions for child survival."

"This project represents a tremendous opportunity for continuing to improve child health care in Bangladesh and is a strong commitment to injury research," said Olakunle Alonge, assistant scientist in JH-IIRU and program manager for SoLiD.

Bloomberg Philanthropies is also supporting the World Health Organization (WHO) to publish an evidence-based global report on drowning prevention later this year and provide expert guidance on effective strategies to combat this burgeoning epidemic and save thousands of lives.

The Johns Hopkins International Injury Research Unit is pleased to offer a free, online certificate training program, Road Traffic Injury Prevention and Control in Low- and Middle-Income Countries (RTIP).

This comprehensive program is comprised of seven multimedia educational modules, covering a wide range of topics, from the basics of road traffic injury prevention to setting up injury surveillance systems, evaluating road safety interventions and influencing policy on road traffic injuries (RTIs). The lectures are taught by a variety of instructors, including JH-IIRU faculty as well as experts in the field of injury prevention control and trauma care from around the world.

The program is free of cost and open to policy makers, researchers, educators and anyone in the general public interested in learning more about RTIs. To date, more than 400 people have enrolled from nearly 80 different countries with close to 30 certificates issued.

We do not offer academic credit, but do provide a certificate for completing course modules.

On October 10-11, JH-IIRU hosted two experts to discuss care of the injured patient in low- and middle-income countries. Hosted by associate director, Kent Stevens, the experts met with members of the JH-IIRU team.

Dr. Razzak is a long-time JH-IIRU collaborator and affiliated faculty member who is currently serving as the chairman of the Department of Emergency Medicine at Aga Khan University and Director of the WHO Collaborating Center in Emergency Medicine and Trauma at the Aga Khan University in Pakistan. Dr. Razzak is also part of the Aman Foundation, a non-profit trust located and operating in Pakistan. The foundation aims to make strategic interventions in the country to support development in the areas of healthcare, education and nutrition. Dr. Razzak is CEO of AmanHealth, which oversees the foundation’s emergency medical service, AmanAmbulance. This service consists of a strategically positioned network of 100 state-of-the-art ambulances, with doctors and emergency medical technicians (EMTs) on board to provide comprehensive, round-the-clock coverage to the city of Karachi.

Dr. Rizwan Naseer is the Director General of The Punjab Emergency Service (Rescue 1122), the largest emergency humanitarian service of Pakistan. Rescue 1122 was developed in response to the failure of repeated attempts to revitalize and modernize the old organizations mandated for emergency management. Because of the services performance during emergencies and disasters in recent years, Rescue 1122 has been designated a Disaster Response Force by the Provincial Disaster Management Authority (PDMA), Government of the Punjab.

The experts discussed the Bloomberg Philanthropies Global Road Safety Program, as well as trauma care efforts in Kenya and how to apply the work of JH-IIRU, the Aman Foundation and Rescue 1122 in the developing world.

By all accounts, the meeting was very successful, and JH-IIRU looks forward to further collaborations with Dr. Razzak and Dr. Naseer.

On October 9, 2013, JH-IIRU director, Adnan Hyder, associate director, Kent Stevens and faculty member, Amber Mehmood participated in the American College of Surgeons Annual Clinical Congress in Washington DC.

In the panel, “Developing, Implementing and Evaluating Trauma Care Systems: Experiences from Low- and Middle-Income Countries,” Dr. Stevens discussed the trauma care work in Kenya as part of the Bloomberg Philanthropies Global Road Safety Program, and Dr. Mehmood discussed Pakistan’s efforts in trauma care and management. Also participating in the panel was former JH-IIRU post doctoral fellow, Hadley Wesson, who discussed trauma surveillance work at the Red Cross Memorial Children’s Hospital in Cape Town, South Africa.

The panel, moderated by Dr. James Neifeld, a surgical oncologist at the Virginia Commonwealth University Department of Surgery and past JH-IIRU collaborator and co-moderated by Dr. Hyder, focused on trauma care systems in low- and middle-income countries. The panel aimed to demonstrate that established interventions can make a significant impact on injury prevention and public health, while highlighting fundamental elements in strengthening the care of the injured patient, such as defining the epidemiology of trauma care injuries, implementing evidence-based trauma care interventions, and assessing the overall impact of these interventions.

This year marks the 100 year anniversary of the founding of the American College of Surgeons. The American College of Surgeons is a scientific and educational association of surgeons that was founded in 1913 to improve the quality of care for the surgical patient by setting high standards for surgical education and practice. The College currently has approximately 78,000 members, including more than 4,000 Fellows in other countries, making it the largest organization of surgeons in the world. There are presently more than 2,600 Associate Fellows.

In Pakistan, injuries and trauma are among the top ten contributors to the burden of disease and disabilities. Other related factors, such as poverty, political instability, and natural disasters as well as the lack of legislation or enforcement of preventative measures contribute to the population’s susceptibility to injuries.

While police and hospital records provide some data on injuries, a recent commentary published in Public Health suggests that it is essential that the public health sector invest in injury prevention by creating a strong, evidence-based strategy, improving national polices, and collaborating with the private sector to promote injury prevention.

In “The challenges of injuries and trauma in Pakistan: An opportunity for concerted action,” JH-IIRU director, Adnan Hyder and Aga Khan University professor, Junaid Razzak, examine the current status of injury prevention and control in Pakistan as well as the burden and the policy context for interventions in the country.

The commentary goes on to suggest that, because injury prevention and emergency care have been proven to be some of the most cost-effective interventions in the health sector, investing in such measures as traffic enforcement, speed control, helmets, child resistant containers and trained emergency personnel makes sense from both an economic and public health viewpoint.

Drs. Hyder and Razzak are directors of the JHU-Pakistan Fogarty International Collaborative Trauma and Injury Research Training Program (JHU-Pakistan ICIRT). The goal of JHU-Pakistan ICIRT is to build a strong network of professionals and help develop sustainable research capacity on acute care of trauma and injuries and emergency medicine in Pakistan. For additional information on the program, click here: